Agreement between multiparametric MRI (PIVOT), Doppler ultrasound, and near-infrared spectroscopy-based assessments of skeletal muscle oxygenation and perfusion.

Skeletal muscle perfusion and oxygenation are commonly evaluated using Doppler ultrasound and near-infrared spectroscopy (NIRS) techniques. However, a recently developed magnetic resonance imaging (MRI) sequence, termed PIVOT, permits the simultaneous collection of skeletal muscle perfusion and T2* (an index of skeletal muscle oxygenation). PURPOSE: To determine the level of agreement between PIVOT, Doppler ultrasound, and NIRS-based assessments of skeletal muscle perfusion and oxygenation. METHODS: Twelve healthy volunteers (8 females, 25 ± 3 years, 170 ± 11 cm, 71.5 ± 8.0 kg) performed six total reactive hyperemia protocols. During three of these reactive hyperemia protocols, Tissue Saturation Index (TSI) and oxygenated hemoglobin (O2Hb) were recorded from the medial gastrocnemius (MG) and tibialis anterior (TA), and blood flow velocity was recorded from the popliteal artery (BFvpop) via Doppler Ultrasound. The other three trials were performed inside the bore of a 3 T MRI scanner, and the PIVOT sequence was used to assess perfusion (PIVOTperf) and oxygenation (T2*) of the medial gastrocnemius and tibialis anterior muscles. Positive incremental areas under the curve (iAUC) and times to peak (TTP) were calculated for each variable, and the level of agreement between collection methods was evaluated via Bland-Altman analyses and Spearman's Rho correlation analyses. RESULTS: The only significant bivariate relationships observed were between the T2* vs. TSI iAUC and PIVOTperf vs. BFvpop values recorded from the MG. Significant mean differences were observed for all comparisons (all P ≤ 0.038), and significant proportional biases were observed for the PIVOTperf vs. tHb TTP (R2 = 0.848, P < 0.001) and T2* vs. TSI TTP comparisons in the TA (R2 = 0.488, P = 0.011), and the PIVOTperf vs. BFvpop iAUC (R2 = 0.477, P = 0.013) and time to peak (R2 = 0.851, P < 0.001) comparisons in the MG. CONCLUSIONS: Our findings suggest that the PIVOT technique has, at best, a moderate level of agreement with Doppler ultrasound and NIRS assessment methods and is subject to significant proportional bias. These findings do not challenge the accuracy of either measurement technique but instead reflect differences in the vascular compartments, sampling volumes, and parameters being evaluated.

Lack of Association of Elder Mistreatment With Mortality.

BACKGROUND: Prior research is limited and inconsistent on the degree to which elder mistreatment (EM) is associated with mortality. This study uses data from a 10-year, prospective, population-based study of EM to determine the adjusted effects of EM on older adult mortality, after controlling for other health and socioeconomic covariates. METHODS: The New York State Elder Mistreatment Prevalence Study conducted a random-sample telephone survey of older adults (n = 4 156) in 2009 (Wave 1). The current study employs EM and covariate data from Wave 1 and data on mortality status through Wave 2 (2019). EM was operationalized both as experiencing EM and as severity of EM. The survey measured overall EM and separate subtypes (emotional, physical, and financial abuse, and neglect). RESULTS: The hypothesis was not supported that abused and neglected older people would have higher rates of death over the study. Individuals who were victims of EM were no more likely to die over the following 10 years, compared with those who were not mistreated, after controlling for covariates. Furthermore, the severity of EM, as measured by the frequency of mistreatment behaviors, also was not associated with mortality risk. CONCLUSIONS: The finding that self-reported EM did not raise the risk of earlier death in this sample is encouraging. Future research should work to identify factors that may moderate the relationship between EM and mortality, such as social support/isolation, quality of family relationships, or involvement with formal support service systems.

Estimated Incidence and Factors Associated With Risk of Elder Mistreatment in New York State.

Importance: Elder mistreatment is associated with major health and psychosocial consequences and is recognized by clinicians, policy makers, and researchers as a pervasive problem affecting a rapidly aging global population. Objective: To estimate the incidence of elder mistreatment and identify factors associated with the risk of new cases. Design, Setting, and Participants: This research is a 10-year, longitudinal, population-based, cohort study of the incidence of elder mistreatment in New York State households conducted between 2009 (wave 1) and 2019 (wave 2). At wave 1, random digit-dial (landline and cellular telephones) stratified sampling was done to recruit English-speaking and/or Spanish-speaking, cognitively intact, community-dwelling older adults (aged ≥60 years) across New York State. The current study conducted computer-assisted telephone interviews with older adults who participated in wave 1 and gave permission to be contacted again for wave 2 interviews (response rate, 60.7%). Data analysis was performed from October 2020 to January 2021. Exposures: Physical factors (health status, functional capacity, and age), living arrangement (coresidence), and sociocultural characteristics (sex, race/ethnicity, geocultural context, and household income). Main Outcomes and Measures: Ten-year incidence for overall elder mistreatment and subtypes (financial abuse, emotional or psychological abuse, physical abuse, and neglect) were measured using adapted versions of the Conflict Tactics Scale, the Duke Older Americans Resources and Services scale, and the New York State Elder Mistreatment Prevalence Study financial abuse tool. Results: The analytical sample included 628 older adults (mean [SD] age at wave 1, 69.20 [6.95] years; age at wave 2, 79.40 [6.93] years; 504 non-Hispanic White individuals [80.9%]; 406 women [64.6%]). Ten-year incidence rates were 11.4% (95% CI, 8.8%-14.3%) for overall elder mistreatment, 8.5% (95% CI, 6.3%-10.9%) for financial abuse, 4.1% (95% CI, 2.6%-5.7%) for emotional abuse, 2.3% (95% CI, 1.2%-3.6%) for physical abuse, and 1.0% (95% CI, 0.3%-1.8%) for neglect. Poor self-rated health at wave 1 was associated with increased risk at wave 2 of new overall mistreatment (odds ratio [OR], 2.86; 95% CI, 1.35-5.84), emotional abuse (OR, 3.67; 95% CI, 1.15-11.15), physical abuse (OR, 4.21; 95% CI, 1.14-13.70), and financial abuse (OR, 2.80; 95% CI, 1.16-6.38). Compared with non-Hispanic White participants, Black participants were at heightened risk of overall mistreatment (OR, 2.61; 95% CI, 1.16-5.70) and financial abuse (OR, 2.80; 95% CI, 1.09-6.91). A change from coresidence to living alone was associated with increased risk of financial abuse (OR, 2.74; 95% CI, 1.01-7.21). Conclusions and Relevance: These findings suggest that health care visits may be important opportunities to detect older adults who are at risk of mistreatment. Race is highlighted as an important social determinant for elder mistreatment requiring urgent attention.

Nurse home visitation and the prevention of child maltreatment: impact on the timing of official reports.

This study examined the effects of the Nurse Family Partnership (NFP), a program of prenatal and infancy home visiting by nurses, on the timing of verified reports of child maltreatment. A sample of predominantly unmarried, low-income mothers and their first-born children were randomly assigned to receive either home visitation services by nurses beginning in pregnancy and lasting until the child was age 2, or comparison services. Previous studies have found that this program was effective in reducing the overall number of substantiated Child Protective Service reports by age 15. In the current study, survival analyses were used to assess temporal differences between nurse visited (n = 93) and comparison (n = 144) children's onset rates for maltreatment. The two groups' survival functions remained nearly identical until age 4, at which point the nurse-visited group's risk for onset began to significantly diminish. These results were more pronounced among the highest risk subgroup and among victims of neglect. The findings provide evidence that the NFP's success in reducing the number of maltreatment reports resulted in part from in its impact on the timing of the maltreatment process.

Variation in nonsuicidal self-injury: identification and features of latent classes in a college population of emerging adults.

Prior studies of nonsuicidal self-injury (NSSI) suggest the existence of multiple NSSI typologies. Using data from 2,101 university students, this study employed latent class analysis to investigate NSSI typologies. Results show a good fitting 3-class solution with distinct quantitative and qualitative differences. Class 1 was composed largely of women using 1 form to engage in superficial tissue damage with moderate (< 11) lifetime incidents. Class 2 was composed predominately of men using 1 to 3 forms to engage in self-battery and light tissue damage, with low (2-10) lifetime incidents. Class 3 was composed largely of women using more than 3 self-injury forms and engaging in behaviors with the potential for a high degree of tissue damage with moderate to high numbers of lifetime incidents. All 3 classes were at elevated risk for adverse conditions when compared to no-NSSI respondents. We conclude that NSSI typologies exist and may warrant differential clinical assessment and treatment.

Revictimization After Adolescent Dating Violence in a Matched, National Sample of Youth.

PURPOSE: To assess if adolescent dating violence was associated with physical intimate partner violence victimization in adulthood, using a comprehensive propensity score to create a matched group of victims and nonvictims. METHODS: Secondary analysis of waves 1 (1994-1995), 2 (1996), 3 (2001-2002) and 4 (2007-2008) of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of US high schools and middle schools. Individuals aged 12-18 reporting adolescent dating violence between the wave 1 and 2 interviews (n = 732) were matched to nonvictimized participants of the same sex (n = 1,429) using propensity score matching. These participants were followed up approximately 5 (wave 3) and 12 (wave 4) years later. At both follow-up points, physical violence victimization by a current partner was assessed. Data were analyzed using path models. RESULTS: Compared with the matched no victimization group, individuals reporting adolescent dating violence were more likely to experience physical intimate partner violence approximately 12 years later (wave 4), through the experience of 5-year (wave 3) victimization. This path held for males and females. CONCLUSIONS: Results from this sample matched on key risk variables suggest that violence first experienced in adolescent relationships may become chronic, confirming adolescent dating violence as an important risk factor for adult partner violence. Findings from this study underscore the critical role of primary and secondary prevention for adolescent dating violence.

The Prevention of Child Maltreatment Through the Nurse Family Partnership Program: Mediating Effects in a Long-Term Follow-Up Study.

We examine maternal life-course mediators of the impact of a nurse home visitation program on reducing child maltreatment among participants in the Elmira trial of the Nurse Family Partnership program from the first child's birth through age 15. For women having experienced low to moderate levels of domestic violence, program effects on the number of confirmed maltreatment reports were mediated by reductions in numbers of subsequent children born to mothers and their reported use of public assistance. Together, the two mediators explained nearly one half of the total effect of nurse home visiting on child maltreatment. The long-term success of this program on reducing child maltreatment can be explained, at least in part, by its positive effect on pregnancy planning and economic self-sufficiency.

The virtual cutting edge: the internet and adolescent self-injury.

The 2 studies reported here use observational data from message boards to investigate how adolescents solicit and share information related to self-injurious behavior. Study 1 examines the prevalence and nature of these message boards, their users, and most commonly discussed topics. Study 2 was intended to explore the correlations between content areas raised for discussion. Both studies were intended to shed light on the role of message boards in spreading information about self-injurious practices and influencing help-seeking behavior. More than 400 self-injury message boards were identified. Most are populated by females who describe themselves as between 12 and 20 years of age. Findings show that online interactions clearly provide essential social support for otherwise isolated adolescents, but they may also normalize and encourage self-injurious behavior and add potentially lethal behaviors to the repertoire of established adolescent self-injurers and those exploring identity options.

Prenatal cocaine exposure and child welfare outcomes.

This study examines the relationship between prenatal cocaine exposure and child welfare outcomes. Seventy-six infants positive for cocaine at birth were matched to 76 negative infants. With prenatal care and maternal use of alcohol and tobacco controlled, cocaine-exposed infants had significant decrements in birth weight, length, head circumference, and depressed 5-min Apgar scores. This confirmed the health risk of prenatal cocaine exposure for the sample. Three-year follow-up data were obtained from the State Central Register and foster care records. Adjusting for prior maternal involvement with child welfare services the study groups did not differ in incidents of child maltreatment or foster care placement. These findings suggest that prenatal cocaine exposure is not a marker for abusive parenting. However, from the perspective of a cumulative risk model, the identification of cocaine-exposed infants at birth can form the starting point for the development of appropriate diagnostic and follow-up services for mother and child.

Childhood psychological maltreatment subtypes and adolescent depressive symptoms.

The aim of this study was to understand how subtypes and the timing of psychological maltreatment contribute to adolescent depressive symptoms at age 14. The sample included 638 youth from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). At age 12, youth reported experiences of psychological maltreatment (degradation, isolating, and terrorizing), physical abuse (endangerment and physical injury), and sexual abuse that occurred before and during elementary school/last year. Multivariable regression models were conducted separately for females and males at each of the two time periods and accounted for demographics, primary caregiver depressive symptoms, other maltreatment subtypes, and youth-reported age 12 depressive symptoms. For girls, caregiver degradation was the only maltreatment subtype that contributed unique variance to depressive symptoms. Degradation before elementary school and chronic degradation had a stronger impact on depression symptoms. Only caregiver isolating behaviors during elementary school/last year and chronic isolation predicted depressive symptoms in boys. These results suggest that childhood psychological maltreatment is multi-dimensional and is implicated in the etiology of adolescent depressive symptoms. Future prevention efforts should consider parental psychological maltreatment in reducing risk for adolescent depression.

Income inequality and child maltreatment in the United States.

OBJECTIVE: To examine the relation between county-level income inequality and rates of child maltreatment. METHODS: Data on substantiated reports of child abuse and neglect from 2005 to 2009 were obtained from the National Child Abuse and Neglect Data System. County-level data on income inequality and children in poverty were obtained from the American Community Survey. Data for additional control variables were obtained from the American Community Survey and the Health Resources and Services Administration Area Resource File. The Gini coefficient was used as the measure of income inequality. Generalized additive models were estimated to explore linear and nonlinear relations among income inequality, poverty, and child maltreatment. In all models, state was included as a fixed effect to control for state-level differences in victim rates. RESULTS: Considerable variation in income inequality and child maltreatment rates was found across the 3142 US counties. Income inequality, as well as child poverty rate, was positively and significantly correlated with child maltreatment rates at the county level. Controlling for child poverty, demographic and economic control variables, and state-level variation in maltreatment rates, there was a significant linear effect of inequality on child maltreatment rates (P < .0001). This effect was stronger for counties with moderate to high levels of child poverty. CONCLUSIONS: Higher income inequality across US counties was significantly associated with higher county-level rates of child maltreatment. The findings contribute to the growing literature linking greater income inequality to a range of poor health and well-being outcomes in infants and children.

Longitudinal associations between teen dating violence victimization and adverse health outcomes.

OBJECTIVE: To determine the longitudinal association between teen dating violence victimization and selected adverse health outcomes. METHODS: Secondary analysis of Waves 1 (1994-1995), 2 (1996), and 3 (2001-2002) of the National Longitudinal Study of Adolescent Health, a nationally representative sample of US high schools and middle schools. Participants were 5681 12- to 18-year-old adolescents who reported heterosexual dating experiences at Wave 2. These participants were followed-up ~5 years later (Wave 3) when they were aged 18 to 25. Physical and psychological dating violence victimization was assessed at Wave 2. Outcome measures were reported at Wave 3, and included depressive symptomatology, self-esteem, antisocial behaviors, sexual risk behaviors, extreme weight control behaviors, suicidal ideation and attempt, substance use (smoking, heavy episodic drinking, marijuana, other drugs), and adult intimate partner violence (IPV) victimization. Data were analyzed by using multivariate linear and logistic regression models. RESULTS: Compared with participants reporting no teen dating violence victimization at Wave 2, female participants experiencing victimization reported increased heavy episodic drinking, depressive symptomatology, suicidal ideation, smoking, and IPV victimization at Wave 3, whereas male participants experiencing victimization reported increased antisocial behaviors, suicidal ideation, marijuana use, and IPV victimization at Wave 3, controlling for sociodemographics, child maltreatment, and pubertal status. CONCLUSIONS: The results from the present analyses suggest that dating violence experienced during adolescence is related to adverse health outcomes in young adulthood. Findings from this study emphasize the importance of screening and offering secondary prevention programs to both male and female victims.

Longitudinal associations between HIV risk reduction and out-of-school time program participation.

PURPOSE: The study aimed to determine the longitudinal associations between several variables assessing positive youth development and HIV risk-reduction practices. METHODS: Participants were 329 youth enrolled in out-of-school time programs in New York City. Longitudinal data were collected in three waves during 2008-2009 (baseline, 6-month follow-up, and 12-month follow-up). Because of the nested nature of the data, multivariate analyses were performed using multilevel models. RESULTS: At baseline, HIV risk reduction was associated with female gender, greater individual-level program participation, and greater school connectedness. Over time, HIV risk reduction was associated with program-level participation: Individuals in groups with program-level participation scores 1 standard deviation below the average showed significant declines in risk reduction practices over the 1-year study period compared with individuals in more participatory programs. CONCLUSIONS: This study provides support for the out-of-school environment as an important context for sustaining HIV risk reduction and positive health promotion practices.

Nonsuicidal self-injury as a gateway to suicide in young adults.

PURPOSE: To investigate the extent to which nonsuicidal self-injury (NSSI) contributes to later suicide thoughts and behaviors (STB) independent of shared risk factors. METHODS: One thousand four hundred and sixty-six students at five U.S. colleges participated in a longitudinal study of the relationship between NSSI and suicide. NSSI, suicide history, and common risk/protective factors were assessed annually for three years. Analyses tested the hypotheses that the practice of NSSI prior to STB and suicide behavior (excluding ideation) reduced inhibition to later STB independent of shared risk factors. Analyses also examined factors that predicted subsequent STB among individuals with NSSI history. RESULTS: History of NSSI did significantly predict concurrent or later STB (AOR 2.8, 95%, CI 1.9-4.1) independent of covariates common to both. Among those with prior or concurrent NSSI, risk of STB is predicted by > 20 lifetime NSSI incidents (AOR 3.8, 95% CI, 1.4-10.3) and history of mental health treatment (AOR 2.2, 95% CI, 1.9-4.6). Risk of moving from NSSI to STB is decreased by presence of meaning in life (AOR .6, 95% CI, .5-.7) and reporting parents as confidants (AOR, .3, 95% CI, .1-.9). CONCLUSIONS: NSSI prior to suicide behavior serves as a "gateway" behavior for suicide and may reduce inhibition through habituation to self-injury. Treatments focusing on enhancing perceived meaning in life and building positive relationships with others, particularly parents, may be particularly effective in reducing suicide risk among youth with a history of NSSI.

A New Measure for Assessing Youth Program Participation.

Participation in after-school programs is an important lever to improve adolescents' health and well-being; however, well-defined measurement of the quality of participation in these programs is limited. The present study validated a newly designed measure of participation in a sample of urban youth enrolled in community-based after-school programs. Exploratory and confirmatory factor analyses were used to test the structure of the 20-item Tiffany-Eckenrode Program Participation Scale (TEPPS). Results suggest that the scale is comprised of four subscales (Personal Development, Voice/Influence, Safety/Support and Community Engagement). The TEPPS was also correlated with several commonly used measures of program participation. Findings from this paper provide support for the use of the newly designed scale as a valid and reliable measure of quality program participation by youth.

Nonsuicidal self-injury in a college population: general trends and sex differences.

OBJECTIVE: To describe basic nonsuicidal self-injury (NSSI) characteristics and to explore sex differences. METHODS: A random sample from 8 universities were invited to participate in a Web-based survey in 2006-2007; 38.9% (n = 14,372) participated. Analysis assessed sex differences in NSSI prevalence, practices, severity, perceived dependency, and help-seeking; adjusted odds ratios for NSSI characteristics were calculated by sex status. RESULTS: Lifetime NSSI prevalence rates averaged 15.3%. Females were more likely than males to self-injure because they were upset (adjusted odds ratio [AOR] = 1.6; 95% confidence interval [CI] = 1.3-2.1) or in hopes that someone would notice them (AOR = 1.6, 95% CI = 1.1-2.7). Males were 1.6 times (95% CI = 1.2-2.2) more likely to report anger and 4.0 times (95% CI = 2.3-6.8) more likely to report intoxication as an initiating factor. Sexual orientation predicted NSSI, particularly for women (Wald F = 8.81, p ≤ .000). Only 8.9% of the NSSI sample reported disclosing NSSI to a mental health professional. CONCLUSIONS: NSSI is common in college populations but varies significantly by sex and sexual orientation. NSSI disclosure is low among both sexes.

Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial.

OBJECTIVE: To examine the effect of prenatal and infancy nurse home visitation on the life course development of 19-year-old youths whose mothers participated in the program. DESIGN: Randomized trial. SETTING: Semirural community in New York. PARTICIPANTS: Three hundred ten youths from the 400 families enrolled in the Elmira Nurse-Family Partnership program. Intervention Families received a mean of 9 home visits (range, 0-16) during pregnancy and 23 (range, 0-59) from birth through the child's second birthday. MAIN OUTCOME MEASURES: Youth self-reports of educational achievement, reproductive behaviors, welfare use, and criminal involvement. RESULTS: Relative to the comparison group, girls in the pregnancy and infancy nurse-visited group were less likely to have been arrested (10% vs 30%; relative risk [RR], 0.33; 95% confidence interval [CI], 0.13-0.82) and convicted (4% vs 20%; 0.20; 0.05-0.85) and had fewer lifetime arrests (mean: 0.10 vs 0.54; incidence RR [IRR], 0.18; 95% CI, 0.06-0.54) and convictions (0.04 vs 0.37; 0.11; 0.02-0.51). Nurse-visited girls born to unmarried and low-income mothers had fewer children (11% vs 30%; RR, 0.35; 95% CI, 0.12-1.02) and less Medicaid use (18% vs 45%; 0.40; 0.18-0.87) than their comparison group counterparts. CONCLUSIONS: Prenatal and infancy home visitation reduced the proportion of girls entering the criminal justice system. For girls born to high-risk mothers, there were additional positive program effects consistent with results from earlier phases of this trial. There were few program effects for boys.

Home visiting for the prevention of child maltreatment: lessons learned during the past 20 years.

For nearly two decades, home visitation has been promoted as a promising strategy to prevent child maltreatment, but reviews of the literature on home visiting programs have been mixed. This article examines how home visitation for the prevention of child maltreatment has evolved during the past 20 years. It reviews several home visitation programs focused on preventing child maltreatment and highlights the Nurse-Family Partnership home visitation program. It discusses how advocacy and public policy for prevention of child maltreatment have shifted from a general call to promote universal home visitation programs to a more refined emphasis on promoting programs that are evidence-based, targeted to those most at risk for maltreatment, and with infrastructure in place to ensure implementation with fidelity to the model tested in trials. Finally, it discusses how primary care providers may advocate to ensure that their patients have access to evidence-based home visiting programs that meet their needs.

Salivary cortisol levels and mood vary by lifetime trauma exposure in a sample of healthy women.

The authors examined the effects of lifetime trauma exposure on salivary cortisol and mood in a sample of women (N = 37) over 25 days before and after a stressful event. The sample excluded posttraumatic stress disorder (PTSD) and major depression and was divided into three groups: (a) no trauma, (b) prior trauma with no peritraumatic symptoms of acute distress, and (c) prior trauma with peritraumatic symptoms. Because results indicated no significant differences between groups one and two, they were combined for analysis. Women reporting prior trauma with symptoms had lower afternoon cortisol levels across time, with sustained negative mood relative to the comparison group. These data suggest the presence of long-term psychophysiological effects of trauma exposure in healthy women.